Ethics of Organ Donation and Transplantation Erin Praver Teona Avaliani Jennifer Sant’anna Ashley Bowman What is Organ Transplantation? An organ transplant is a surgical operation where a failing or damaged organ in the human body is removed and replaced with a new one from either a deceased or living donor. Grafting A graft is similar to a transplant. It is the process of removing tissue from one part of a person’s body (or another person’s body) and surgically re-implanting it to replace or compensate for damaged tissue. Grafting is different from transplantation because it does not remove and replace an entire organ, but rather only a portion. Ethical Issues What is considered dead? Shortage of available organs Religion Priority What is considered dead? Traditionally organ transplantation had been guided by the overarching ethical requirement known as the dead donor rule, which simply states that patients must be declared dead before the removal of any vital organs for transplantation. Characteristics included being cold, blue, stiff, and lack of pulse. Brain Death There have been persistent questions about whether patients with massive brain injury, apnea, and loss of brain-stem reflexes are really dead. When the injury is entirely intracranial, these patients look very much alive: they are warm and pink; they digest and metabolize food, excrete waste, undergo sexual maturation, and can even reproduce. Definition of Brain Death The definition of brain death requires the complete absence of all functions of the entire brain, yet many of these patients retain essential neurologic function, such as the regulated secretion of hypothalamic hormones. Brain Death Justification Some have argued that patients are dead because they are permanently unconscious (which is true). But if this is the justification, then patients in a permanent vegetative state, who breathe spontaneously, should also be diagnosed as dead. Organ Shortage The following information from www.unos.org gives an idea of the extent of the organ shortage: ―On average, 106 people are added to the nation’s organ transplant waiting list each day—one every 14 minutes‖ ―On average, 68 people receive transplants every day from either a lovong or deceased donor‖ ―On average, 17 patients dies every day while awaiting an organ – one person Distributive Justice Due to not enough organs being available for transplantation, the concept of how to fairly divide resources comes into question. Distributive justice theory states that there is not one ―right‖ way to distribute organs, but rather many ways a person could justify giving an organ to one particular individual over someone else. Distributive Justice (Continued) This list of possible distributive justice criteria comes from the University of Washington School of Medicine website: 1. To each person an equal share 2. To each person according to need 3. To each person according to effort 4. To each person according to contribution 5. To each person according to merit 6. To each person according to free-market exchanges Equal Access Organs allocated according to equal access criteria are distributed to patients based on objective factors aimed to limit bias and unfair distribution. Equal Access Criteria Length of time waiting (I.e. first come, first served) Age (I.e. youngest to oldest) Maximum Benefit The goal for maximum benefit criteria is to maximize the rate of successful transplants. Maximum Benefit Criteria Medical need (i.e. the sickest people are given the first opportunity for a transplantable organ) Probable success of a transplant (i.e. giving organs to the person who will be most likely to live the longest) Religion Religious views vary from the acceptable to the damnable. Buddhism Believe organ and tissue donation is a matter that should be left to an individual’s conscience. Catholicism Organ and tissue donation is considered an act of charity and love. Transplants are morally and ethically acceptable to the Vatican. Hinduism Are not prohibited by religious law from donating their organs, according to the Hindu Temple Society of North America. In fact, Hindu mythology includes stories in which parts of the human body are used for the benefit of other humans and society. The act is an individual decision. Gypsies Tend to be against organ donation. Although they have no formal resolution, their opposition is associated with their belief in the afterlife. Gypsies believe that for one year after a person dies, the soul retraces its steps. All parts of the body must remain intact because the soul maintains a physical shape. Islam The majority of Islamic legal scholars have concluded that transplantation of rgans as treatment for otherwise lethal end-stage organ failure is a good thing. Donation by living donors and by deceased donors is not only permitted but encouraged. Anact of merit and in certain circumstances can be an obligation Jehovah’s Witnesses Do not believe that the Bible comments directly on organ transplants, hence: decisions made regarding cornea, kidney, and other tissue transplants must be made by the individual. Are often assumed to be opposed to donation because of their belief against blood transfusion. This merely means that all blood must be removed from the organs and tissues before being transplanted. Judaism In principle Judaism sanctions and encourages organ donation in order to save lives. Transplantation does not desecrate body or show lack of respect for the dead, and any delay in burial to facilitate organ donation is respectful of the descendent. Organ donation saves lives and honors the deceased. Shinto The dead body is considered impure and dangerous, and thus quite powerful. Injuring a dead body is a serious crime. Overall In terms of ethics, it depends on the individual’s (donor) wishes: whether or not they choose to be donors based on their knowledge and beliefs.